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91 JANUARY/FEBRUARY 2018 ● TVPJOURNAL.COM CLINICAL INSIGHTS following the dilated loops of small intestine will facilitate detection of the foreign body. Circumferential loss of the normal, hyperechoic submucosal layer has been shown to represent extensive submucosal ulceration and necrosis, correlated with a greater likelihood of perforation, in humans with appendicitis. 39,40 Intussusception Most intussusceptions occur in young dogs and are secondary to viral, bacterial, and parasitic etiologies. In older dogs or cats, intussusceptions are often triggered by focal infiltrative disease of the intestine, such as neoplasia, and the intestinal wall in the vicinity of the intussusception should be carefully scrutinized to rule out such conditions ( FIGURE 15 ). Intussusceptions are named according to the segments involved. Jejuno-jenunal, ileocolic, and cecocolic (cecal inversion) intussusceptions are the most common types. An intussusception has a multilayered appearance in longitudinal axis and a concentric ring appearance ("bullseye pattern") in transverse axis ( FIGURE 16 ). 8,35,37,41,42 Lymphangiectasia Lymphangiectasia is pathologic dilation and rupture of lymphatic vessels with leakage of lymphatic contents. Intestinal changes consistent with lymphangiectasia include a combination of intestinal wall thickening, linear areas of striated hyperechogenicity of the small intestinal mucosal layer that are perpendicular to the long axis of the intestine, small intestinal wall corrugation, indistinct small intestinal wall layering, and small intestinal hypermotility ( FIGURE 17 ). 43,44 FIGURE 16. Longitudinal (A) and transverse axis (B) views of a segment of small intestines of a dog diagnosed with intussusception. The intussusceptum ( calipers ) is a portion of the small intestines that telescopes into the intussuscipiens ( brackets ). In other words, the intussuscipiens is the recipient of the intussusceptum. Note the multilayered appearance to this segment of small intestine and the demarcation between the intussuscipiens and intussusceptum with the mesenteric fat (M) in the center. A B FIGURE 17. Longitudinal axis view of a segment of duodenum of a dog diagnosed with histopathologically confirmed lymphangiectasia. Note the perpendicularly oriented hyperechoic striations within the mucosal wall of the duodenum. These hyperechoic striations represent dilated lacteals. FIGURE 18. Longitudinal axis view of a segment of jejunum of a dog diagnosed with carcinoma using cytology. Note the severe focal thickening and loss of wall layering forming a heterogeneous hypoechoic mass ( calipers ). The lumen is the hyperechoic interface with distal reverberation artifact and dirty shadowing.